| Saline Versus Nafamostat Mesilate Anticoagulation for Continuous Veno-venous Hemofiltration (CVVH) in Patients at High Risk of Bleeding: A Prospective Study |
| In-Il Park, M.D., Myung-Jin Choi, M.D., Jong-Woo Yoon, M.D., Young-Ki Lee, M.D., Sung-Gyun Kim, M.D., Ji-Eun Oh, M.D., Jang-Won Seo, M.D., Hyung-Jik Kim, M.D., Jung-Woo Noh, M.D. and Ja-Ryong Koo, M.D. |
| Division of Nephrology and Hallym Kidney Research Institute Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Korea |
| 임상연구 : 출혈 위험성이 있는 환자에서 지속적 정정맥 여과술 시행 시 생리식염수 주사와 nafamostat mesilate의 항응고 효과의 전향적 비교 연구 |
| 박인일, 최명진, 윤종우, 오지은, 서장원, 김성균, 이영기, 김형직, 노정우, 구자룡 |
| 한림대학교 의과대학 신장내과, 신장연구소 |
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| Abstract |
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Purpose:In patients with a higherrisk of bleeding, performing CVVH with heparin or saline anticoagulation is associated with increased bleeding or thrombotic risk. Nafamostat mesilate (NM), a serine proteinase inhibitor, while inhibiting various clotting factors in filter circuit, is characterized by short half life resulting in little systemic anticoagulation effect. Accordingly, we prospectively evaluated the anticoagulant effect and safety of NM in patients with a higher risk of bleeding who underwent CVVH.
Methods:Among 43 patients with high risk of bleeding [defined by (1) INR>2, aPTT>20 sec, platelet< 50,000/mm3 or (2) ongoing bleeding, major hemorrhage/surgery in the last 48 hrs], 20 patients were treated with continuous nafamostat mesilate infusion (10-20 mg/hr) and remaining 23 patients were treated with saline bolus infusion (100 mLq 1 hr) for CVVH anticoagulation.
Results:As compared with saline bolus group, mean circuit life was significantly longer in NM infusion group (28.73±12.67 versus 16.34±7.86, p=0.001). There was no significant bleeding complication in either saline bolus or NMinfusion group. In subgroup analysis according to the presence of abnormal coagulation status (defined by INR>2, aPTT>20 sec, platelet<50,000/mm3), the positive effect of NM on circuit lifespan persisted irrespective of the coagulation status.
Conclusion:As compared with saline bolus, nafamostat mesilate infusion was associated with higher CVVH filter life. In patients with high risk of bleeding, nafamostat mesilate can be used as a safe and effective anticoagulant for CVVH with acceptable filter life. |
| Key Words:
Nafamostat, Anticoagulation, Venovenous hemofiltration |
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